MFC REPORT 2003
Medico Friend Circle Meet
Day I-
28.12.2002
After welcome address and introductions, Anant Phadke has introduced the history of MFC.
He gave a brief analysis of JP movement and the dissatisfaction with teaching in medical colleges. There was a lack of insight on rural and social aspects of health and a strong need for a ‘medical paradigm shift’ was felt. MFC has emerged from this context.
One of the salient feature of MFC is a pluralistic democratic platform sharing a common point of view. Here the coming of the leftist, feminists activists and researchers etc. with different ideologies has led to understand issues that the downtrodden have got a raw deal in many areas of health and social justice especially in the rural areas. MFC initially was more focused on rural healthcare but now expanded to include the issues that concern the Indian Health scenario at different levels. As a collective action MFC has intervened in disasters, such as Bhopal Gas Tragedy and the Gujarat Carnage. MFC had done the first epidemiological study, at Bhopal after the Bhopal Gas Tragedy.
He gave prominence to MFC not being just an organization neither a group of intellectuals in a scholastic forum but a group of friends who has a role to play, like the network such as AIDAN has emerged. It has also made an organic connection with the grassroots work.
MFC has been a platform to share views where the members agree and/or disagree. He explains about the nature of debates, which have maintained their academic value and having a close link to the ground realities.
Being in MFC, he pointed out that it is a learning experience with very relevant discussions and debates taking place. MFC is a forum for people to meet and go back with memories of friendship and commonalties. He clearly pointed out that MFC is voluntary and self-funded group.
Sarojini added that MFC has expanded its concern to the issues of communalism and rising fundamentalism in the country. MFC has been working on the issues of social justice, women’s issues and could see a clear impact of communalism on these issues. During carnage in Gujarat , MFC could see the state’s apathy to respond to the situation. There was a complete neglect toward the victims and survivors from the minority community for providing a long term relief. MFC has done an investigation on the public health services and came up with a comprehensive report. She stressed that there is polarisation within the medical profession and MFC felt it is important to address this issue in the annual meet. There is a pressing need to talk about the role of the state, NGOs and medical profession.
Manisha Gupta, said that MFC is a pioneer in taking up issues like occupational health, women and health, having a target free approach. It has some good publication like the study on Depo-Provera.
Session
I
CONTEXTUALISING THE COMMUNAL SITUATION TAKING GUJARAT AS A
CASE
Presentation by Chinu Srinivasan, A.A. Sheikh and Dr. Ram
Puniyani (chaired by Dr. Zafarullah Chaudhury)
Chinu
Srinivasan
Chinu started his presentation illustrating that the doctors as a group in society has worked with respect and being leaders in the medical profession should be impartial. In the context of what happened in Gujarat the role played and/or not played by the group has serious consequences. The doctors failed to look at the psycho-social aspects of the violence and just focused on the clinical aspects.
The doctors did a survey in April/May at Ahmedabad, Baroda, filtering out important circumstantial facts. The gruesome violence of Gujarat riots had an active state & police involvement. It was revealed that Hindu doctors do not believe in discriminations, as there were no complaints from Muslim patients. But then Hindu doctors did not raise their voice against violence apart from the clinical context thus being guilty by acquiescence. On the contrary, nearly 1,000 doctors actively campaigned for the BJP thus violating the medical ethics. The profession was brought under disrepute by some doctors. Moreover there is a failure of conscience of civil society and the Hindu community. Hence there is a strict need to sensitize the doctors with the medical profession and develop a humanistic perspective.
Mr. Sheikh,
Muslim Medical Trust
He started by saying that there are enough reasons for the carnage, but the major reason was ‘power’. BJP was losing all elections from Gram Panchayat onwards and were desperate to regain power. Hence they used religion to recover their political power. With regard to religion and politics people have fixed ideas. It is easy to instigate people on these concepts. Temple and terror is said to be the only combination to rule.
The first communal riot in Gujarat in 1969 was the biggest and the largest was in 2002. While the 1969 riot touched only the major pockets of the urban areas but the present one spread even to the remote areas, tribal belts and in cities as ghettoization/polarization occurred after 1969. At Panchmahal, the most effected area where even the tribals got instigated. They were earlier docile but now are participating in loot, rape, murder and the like. Such kind of a massacre should not be repeated in other states. The psyche has affected even the children.
He gave the example of his own hospital, which is in the Hindu area. It has 25 beds with 80% of the patients being Hindus and 20% Muslims. During the riots this hospital was burnt down that is now rebuilt. The hospital will remain closed on 14th /15th January, on the occasion of Sankranti festival, for kite flying.
During his presentation, he divided Gujarat into two groups of people- affected and non-effected. People have different responses to what happened based on their experiences. While people were being killed in Old Ahmedabad, Mc Donalds’ was being inaugurated in New Ahmedabad, where more than 5,000 people were celebrating. He ended up saying that the non affected should not wait to be affected but should react and act before getting affected. We need to act before this act gets repeated.
Dr Ram Puniyani
He started by saying how the media presents the riots. For example, Christians killed in Pakistan, was printed on the page no 1 while the Malegaon riots where the Muslims were killed in 2001 was shown in page number 3 and Hindus attacked in Bangladesh in page number 6. The kind of preference was pointed out.
He then forwarded the discussion over the issues of communal violence and communal politics. He said that the threat to the current society is communal violence and emphasised on what doctors can possibly do. It is commonly seen that the victims of communal violence are generally innocent, while the perpetrators go scot-free and gets political/social promotion. The main persons spearheading becomes a hero, while the vulnerable minority projected as a threat to society.. This shows that the aggressor is projected as protector of majority community and the victim projected as culprit. Communal violence leads to a short term and long term polarization. He citied examples of 1983 Sikh riots where 3000 Sikhs were killed but still Congress won. In 1993 Mumbai- Shiv Sena government came to power. In the similar manner during the Gujarat riots in 2002, BJP won.
He said that communal violence is the tip of the iceberg, the real danger is the communal politics. Politics has two sides; one democratic which is based on issues of real life and second one is communal based on religious community that is monolith- having same interests- it is projected that interests of one community are common and are different and hostile to the interests of another community. To carry these interest forward, this kind of politics is harbored.
He gave a systematic analysis on the reasons for communal violence as; a)Social common sense- average persons in society believe what politicians say;
b)Broad prevalence of myths- systematically promulgated so that they become part of consciousness of society;
c)Myths abounding but false also - at 3 levels. Firstly, at the level of history- how Islam spread. Secondly, the demographic and social aspects- like having 4 wives, bathing once a week etc. Thirdly, in terrorism generally Muslims were pointed out, Sikh/LTTE got dwarfed. Everybody feels what they understand is correct. This legitimizes the violence as its alright to eliminate such a group of people.
Ram Puniyani then gave a brief account of the beginning of the communal politics in India. It began with the freedom movement and the INC , enveloping the concept of India in the making. Certain groups believe that their nation exists for the past 5000 to 10,000 years. With the independence there has been a transformation in social relationships, caste structures and gender relationships:
1. Land slaves were becoming workers
2. Industrialisation was on the rise
3. A new educated class has emerged.
He continued his presentation that in the late 19th century there was a change in the hierarchies:
•There was a challenge to the authority of the landlord with the commencement of anti-Brahmin movement.
•Power of the landlord runs parallel to the moral authority of the priest.
•Shudras no longer wants to be subordinates.
•Phules’s movement emphasised on women’s education, consequently their participation in the freedom struggle have made them to deny their subordinate position with regard to men.
•In the process, Muslim-Hindu traditionalists came up to the fore. Muslim organizations work towards Muslim League. The demand of Muslim League was for a separate nation. On the other hand, Hindu Mahasabha felt the land belongs to the Hindus. Both claimed to represent their respective communities. In 1937, 1946 elections- Muslim League had 3.6% and Hindu Mahasabha 1.9% while the rest of the votes went to the Gandhian INC- which was able to weave together people of all religions and to build India as a Nation-State.
Ram Puniyani during the course of presentation explained the words : “Hindu,”, “Hindutva” and HinduRashtra”. He said that the term “Hindu” had a geographical concept, which has now changed to having a religious connotation denoting followers of the Hindu Brahminical religion, based on gender and caste hierarchy and not the stream of saintly personalities like, Kabir, Gandhi, Tukaram. On the other hand, the term Hindutva, popularized from 1930 onwards, not for religious purposes but for political needs- enhancing the elite Brahminical values, race and culture. Hindu Rashtra,
He talked of revolution and counter revolutions that commenced by the end of 19th century. There was a transformation of caste and gender relationships It got accentuated in 1950 to 1980, during the Nehru’s and Ambedkars’ revolution. From 1980 onwards there was a counter revolution against these changing relationships.
History of RSS: National Swayamsewak Sangh, is a volunteer organization. It calls itself “National” Sangh Parivar, a multi-headed hydra having a deeper unity regarding agenda and organizational agenda. As all organizations, these were led by RSS volunteers having central controlling members ( >50% are RSS).
RSS was formed in 1925 at Nagpur when the anti- landlord movement was at its peak. During this period Gandhi had entered the INC and made it a mass movement. The group of Brahminical politicians grip was loosening in the INC.
He pointed out that five founding members were Chittapavan Brahmins, out of which four were doctors. They personified patriarchal values by not allowing women in the organization. RSS decided to remain aloof from the freedom struggle, with the notion of Hindutva-man and Hindu- jeevan.
Malatibai Kelkar approached RSS but she was refused on the grounds that women are supposed to take care of kitchen and children. Within the RSS terminology ‘’Swayam’ means in the pocket of father / husband / children. On the similar grounds she formed Rashtra “Sevika’ Samiti, which had a deeper commitment to the patriarchal ideology.
In 1948, Gandhi was killed and Sardar Vallabhai Patel banned RSS. He wrote to RSS chief that RSS was responsible for the communal poison that killed Gandhiji.
Ram Puniyani indicated that RSS is trying to present Manu’s values in a modern fashion, which is still a challenge among them. The Hindu movement was dormant till 1980. In 1985, it was anti-dalit (anti-reservation) but now in Gujarat, it seems to be anti-Muslim. Golvalkar, the second Sarsang chalak had a bunch of thoughts to retain the hierarchical culture - culture of nationalism; and said that Manu’s ideas are eternal.
Dr. B.R. Amedkar - the founder of our Constitution had failed in many of his earlier campaigns. He burnt Manu Smriti; the symbol of gender and caste hierarchy. K.S. Sudarshan(RSS) in 1998 said “ Indian constitution is not Indian, based on Western values; should be changed to be based on holy scriptures of Hinduism.”
Puniyani’s presentation was followed by discussions:
Dr. Bashir said that due to some genuine reasons when the minority patients were not attended for 15-20 minutes they came up to the conclusion that they were neglected. he felt that it was due to the fear complex among the minority patients. Moreover the entry of doctors into institutions who owe their allegiance to the VHP is another reason for the fear among Muslim patients. He continued saying that majority of the doctors were not communalized. The surrounding atmosphere had flared up the situation but still the doctors have been performing their clinical responsibilities.
Maya Valecha, said that most of the doctors are part of the elite. Our task is to get more of them. We need to emphasise on the affected/non-affected and not just the minority. Moreover, the inactivity is moving them in the other direction.
Sheikh emphasised on a planned event. He pointed out how the business men and the politicians are using Dalits and Adivasis so easily. He questions as to who is to be blamed? The ‘thinkers’ or the ‘doers’.
Bina Srinivasan said that assuming that the tribal communities are homogeneous is not right. Hindutva forces have systematically infiltrated and indoctrinated the educational institutions as well .Along with the Dalits and women an artificial unity was forged against Muslim community. There is a anti-democratic thrust within the institutions. Communal riots was always given an anti-Muslim turn. The entire support structures to Dalits was broken. Consequently many Dalit families had committed suicide.
Abhay Shukla said that with the beginning of globalisation since 1980s, there has been a weakening of the nation-state, economically and culturally. This was the starting of the counter revolution. People have lost faith and identity, there is a rise of fundamentalism, racism etc. Moreover, the Indian nation-state weakened as a developmental entity- socially & economically as many decisions were taken by other agencies; the community based identities were broken down as pseudo-identities based on religion (eg. victory over Pakistan) has usurped the psyche of the people. Islamic Fundamentalism being presented as a pretext and US actively furthering this fundamentalism.
Post Lunch
Session
Professor
Ghanshyam Shah
Ghanshyam Shah started his presentation with the explanation of the word ‘community’. He explained it in two ways: “on the basis of geographical area” and “on the feelings and emotions attached“. He emphasised saying that community is made up of human beings which is not stagnant but one which is constantly changing, and is constructed over a period of time with certain stereotypes present within the community.
According to the investigation by the Citizen’s Initiative findings, doctors constitute a part of the larger society and during the genocide they have tried to maintain the neutrality. They are not supposed to be considered as superhuman.
He continued saying that central to communalism is social common sense which erupted as one of the issues in the Gujarat Genocide and the emergence of ‘false consciousness’ has led to what happened in Gujarat. The social common sense and the consciousness both has to be questioned. A political community has been formulated to perpetrate communal politics. Thus the sense of community present has been manipulated for the construction of the Hindu Rashtra.
He felt RSS/ VHP to be manipulating the society along communal lines. Rule of Moghuls is not remembered with hatred. Jains, Hindus and Brahmins were not involved until Somnath temple was attacked. Categorically the hurt to a symbol led to a slow division of society along communal lines in the mid- nineteenth century.
Secondly, categorization was borrowed from British historians, i.e., by 1856 history writing was done by British Civil Servants along the lines of Hindu-Muslim-British categorization. In 1885 various conflicts erupted which was on the similar categories. Then came Gandhian ideology within the categories by 1917. In 1925 RSS was formed with the ideology of spreading the fire of communalism.
The coming of Hindu Mahasabha and the RSS books were written on “Chatrapati Shivaji Maharaj” led to the glorification of Shivaji, Kanhaiyalal Munshi wrote about Gujarati Rashtra and Gujarati Asmita, which gave a notion of Hindutva. He said about Kanhaiyalal that he was a historian whenever convenient and a creative writer other wise. During this time the Muslim league was not insignificant and had won 3/4th reserved seats for Muslims in 1935-36 in the Municipal Elections, Hindu Mahasabha did not have a base at this time. Kanhaiya Lal Munshi was removed from INC by Gandhiji who later on went to express openly his support for RSS.
He gave a sequence of the happenings at that period, which was taken advantage by the RSS. The 1965-69 was a formative period for RSS, especially around the first Indo-Pak War. Golvalkar addressed the border-state fear. During this time period a lot of refugees(Sindhis& Punjabis) came to Gujarat. The 1969 riots in Gujarat was followed by the mass movement against Cow slaughter lead by Sambhuji Maharaj. In the Navnirman Movement of 1973-74 they had a good foothold. During the emergency, the right wing got good space and legitimacy due to the anti-emergency campaign they staged.
After the emergency, some BJP members like the Jan Sangh, were part of the government who slowly started patronizing these parties. In 1980s, they worked against price hike, electricity hike and hijacked the Ambedkar movement.
Dalit political movement came into Gujarat after 1960. Reform of Adivasis was done symbolically, like taking a bath and putting tilak on the forehead, wanting to create an ethos. Their unconscious hinduization took place in the name of reform. In 1930s the so-called reform against Parsis, 1947 against banias, and in 1990s against Muslims. It was perceived that religious ethos has nothing to do with communalization, those who were religious were not necessarily communal. On the contrary, the communal consciousness of the community had been changing and categorically increased. Sufism( Sufis were considered as “Hidden Muslims”) had been attacked including dargahs, it was an attack on composite culture. Gujarat has a lot of sects- that focuses on the altered reality that RSS/VHP projects. From 1995, till today the power was systematically used to change text books, control NGOs, hijack Dalits etc.
Professor
Shah’s presentation was followed by some
discussion:
Anant said that there was no renaissance in rural India. Democracy in India is skin deep since there was no renaissance as in Europe. There is a pluralistic culture in India but the political workers have neglected the socio-cultural traditions and the brahminical anachronism returned, which is trying to rule rural India.
Supporting his statement Ghanshyam Shah said that now we are not sure that India cannot become a Fascist state. We are not able to articulate the democratic state. We have actually ignored the question of identity and sentiments. He gave the example of Swaminarayan who mobilised OBCs, there were no Dalits in it, with patidars the main supporters in it. Swadhyay reconstructs history and Hindu Rashtra.
Chinu talked about democratic multi-culturalism. Globalization is both oppressing and liberating. there is a need to mix the legacy of democracy and Globalization.
Manisha talked about the gradual building up of anti-semetic mood in Germany. The Anti-Semetic party came into fore in 1893. By 1910, Race and Religion found due importance through the Jews and Aryans. The Jewish Doctors were first to be evicted. Interestingly, 61% of the doctors were members of Nazi’s party. On the one hand, Nazi’s supported holistic medicine, anti-smoking and vegetarianism. On the other hand, the Doctors were the first to put forth the theory of racial superiority. They supported euthanasia especially for the children with genetic effects like being non-Aryans. Secondly, the psychiatric patients were put in gas chambers to die. As a matter of fact, the doctors had developed technology like the gas chambers. She concluded by saying that when we talk of middle-caste in that sense, both Christ and Judas belong to the middle caste but it was religious ‘choosiness’ to just have anti-Jewish sentiment in Germany.
Farida ( Bangladesh) : She viewed that Jamaat-i-Islam is the cousin of BJP. The ‘B’ syndrome; i.e. Bush, Blair and Bajpai have made it that all Muslims, including Gujarat Muslims are potential terrorists, even those unborn children who were slit open from the mother’s wombs and thrown into the fire. According to Golvalkar there are three threats to Hinduism literally naming, Christians, Muslims and Communists. She talked of Huntington’s new policy of controlling population among Muslims meaning to reduce terrorists. She concluded saying that none of us could be safe after the September 11, 2001 incident.
Anant Phadke showed the contradiction within the experience of South Maharashtra. He points out that the tradition of democratic rights has to be seen from a different context. We need to go beyond the economic framework and bring in socio-cultural and spiritual frameworks within it.
Zafarullah Chaudhury concluded by saying that there were no riots in West Bengal Or South.. We need to have more courage to stop the riots in other places.
Satyamala answered Mr. Chaudhury that South India has not been in the mainstream. But the movements in South were internalised within the anti-brahmin movements in the last century. The situation now in South India is horrifying. DMK and AIADMK were both with BJP and it is anybody’s guess as to what happens next.
Session
II
Experiences of Health Professionals Intervening in Communal Situations, dilemmas and difficulties of medical professionals and NGO’s working with health about their interventions during the crisis - Is the profession neutral? Or is there a communalisation of the profession?
Presentation by Bashir Ahmedi, Sanjay Nagral and
Nabhojit Roy (Chaired by Satyamala)
1 Bashir Ahmedi started the presentation by saying that he was on leave from February 28th -March 3rd,02. After returning on 4th March he found that there were no patients for a month in OPD, where usually 50- 80 patients used to come in a day. The absence of patients was due to severe curfew, fear and distrust of Government Hospitals. Only 10-11 wards had normal number of patients like 30-40 patients in a ward. Still the majority of the patients were Muslims because V.S. Hospital was run by Ahmedabad Municipal Corporation, where Congress won, though partly paying along with the state government, which was BJP. He said that though majority of the patients got good treatment but because of distrust, the patients thought that discrimination was taking place.
During the stabbing incident, a mob comprising of the Bajrang Dal members with swords entered the hospital and asked the hospital authorities to hand over all the muslim patients who will be “taken care of”.
Within a period of four weeks work came to normal. When he went to two camps he found out that doctors attending the camps were doing their best. But the patients refused to go to the civil hospital due to distrust and fear psychosis became the major limitation. Another limitation cited by Bashir Ahmedi that the Muslim patients felt the Hindu doctors to be discriminatory against them inspite of the fact that they gave medicines as required. Even those who needed regular intakes of medicines were reluctant to go to hospital. He citied the example of two patients of hemiplegia who needed RT feeding but refused to go to the hospital due to fear psychosis.
Within the Ahmedabad Medical Association; the President, Vice-President and Secretary/Treasurer are VHP members. However, while working or treating these doctors do not directly discriminate and are professional. But the fact remains that the political medical practitioners were not competent. Though the profession per se has not been deeply effected. Professional capacity decreased in the camps as the doctors had to see 200 patients in line and also they did not have investigations done. Even the nursing staff did exemplary work during the riots. He put forth the point that individual action and group action differs, Volags were also there at the relief camps but were not properly coordinated.
The hygienic conditions in the camp was quite bad. Shelters and medicines were provided to the patients who were recommended by the government. The shelters were inadequate for all. The medicines are not available in bulk but on the basis of requirement that are bought from the shops. He closed his presentation by saying that the Doctor-patient relationship is curative but due to such an incident the situation has worsened the relationship. Multiplicity of voluntary agencies responding to some areas found the patients were there but the doctors went for shopping. Most of the patients who showed weakness and got Iron and Vitamins, to such an extent that it caused diarrhea.
Post Tea session
2. Dr. Sanjay Nagral
The MFC Report on Gujarat carnage shows that there was no proactive role from doctors, the medical profession should have behaved in a more responsible manner. The medical profession needs to be reminded of its ethical considerations. It is difficult to make connection between ethics and being secular. By ethics we usually do not go beyond negligence. The riots have brought in the fore the fear psychosis. Hence the secular doctors need to come out in the open and do active work in their institutions so that the resident doctors and nurses get inspired. He tried to raise the question of communalism and said that the Bombay riots did not work in the Suburban shines of Mumbai.
Doctors do not see “ethics” in medical terms. An increasing influence of Sangh Parivar can be seen on the medical profession. Deenanath Mangeshkar Hospital run by RSS where the doctors are sympathizers of RSS. The doctors in these hospitals are chosen on the basis of their connection with RSS. Another such example is of Nana Palkar Smriti Samiti, which helps patients who are related to Sangh Parivar in accessing health care. The level of penetration of the Sangh Parivar is so much that the organisations like National Medical Organisation are dominated by people belonging to RSS.
There is absence of alternate voice in Indian Medical Association. Communal polarization is increasing not only during riots but also in general practice. For example number of hospitals, which are run, by particular group of people for a particular group is growing day by day. Also doctors are seeking help from VHP & RSS to increase their practice. At the end of the presentation Dr. Sanjay Nagral suggested that we should focus our work on some of these identified areas.
Discussions:
Anant Bhan said that the connection between medicine and religion is very old like there are missionary hospitals run by Christians where preference is given to Christian patients.
Dr. Bashir Ahmedi opined that since concession is given to a particular group, it leads to increasing polarisation.
Nagmani Rao raised a concern over decline in liberal thought movement and increasing influence of RSS on younger generation. He also showed how religion infiltrated into social work institutions. The most sensitive and motivated students were found to be from the ABVP/DP background.
According to Sabu George, the medical profession attracts conservatism. The SFI has disappeared for last few years from educational institutions and medical community is becoming a reserved community.
Ravi Duggal informed others that there is constitutional provision for religion based medical institutions and the matter is under consideration in Supreme Court.
Mira Shiva talked about the difference of environment between the Christian Medical institutions and the hospitals run by Hindutvavadi people. Christian nurses face a lot of problems and insecurity while working in Hindutvavadi hospitals. The composition of students in medical college is changing over past few years and a decline in social responsibility is seen due to the growing insecurity.
Amar said about the lack of information about health sector development in India. From seventies the corporate sector has entered into the health sector. Ghettoization and polarisation in the society is increasing which has resulted in increasing number of religion-based hospitals—hospitals set up by /for different communities On Sanjay’s point on “ethics’ Amar questioned that it means mobilise, create our own political force and reorganise the system.
Sanjay added that there is a need to reclaim some of that pace within the medical profession, engage with the problem that medicos face. This will credibility to talk about secularism.
Anil Pilgaonkar said that linking secularism and ethics, which is not well established. He said that health is defined as physical, mental as well as social well being but the social factor was not given much attention. Secular forces have never tried to define social health and neglect of social health is an ethical issue.
Sunil Nandraj pointed out that though we say health professionals, we are just talking about doctors and not other health care providers.
Presentation
by Nabhojit Roy
Then Dr. Nabhojit Roy made a brief presentation about they were not taught to deal with physical violence in medical colleges. The doctors face a lot of difficulties, especially the practicing doctors. Some problems faced by the doctors are that there is nobody to defend doctors, there is lack of data or the doctors do not have courage to publish the data. On the other hand the medical profession has become partisan including the Pharma companies. Taking the example of Doctors in Mumbai, 90% of the doctors are fence sitters - they are non-aligned, their only god is money, which led to act like an equalizing factor.
Discussion
Narendra pointed out that money factor determines ethics.
Manisha asked the legal profession whether they would take a case or not? She questioned that being a rural activists, would they take up a problem or not, if in real danger, can we shift like a Dalit women can’t escape from the land lord will it be taken as a privilege. But once the profession is chosen, we should not give these kind of excuses. We are already privileged so should not find any excuses.
Renu said that she does not think the issue with protection is relevant at that moment. What is right and what is wrong is the question to ask and answer. Most importantly, the medical profession has to answer what they are there for.
Veena pointed out the difficulty of protecting oneself in a crisis situation. What we must deal with is everyday communalism. Ethics is very important and should maintain international standards and also have quality medicines. This would open up many possibilities.
Satya said that we should prepare ourselves to face situation of violence. Taking her own example of starting a hospital in Bilaspur, she was questioned by the villagers, if they belong to the Christian Missionary or a part of RSS. She then asks the participant how do we face a violent mob, how to create a group or force that will stand up in times of crisis.
Farida Akhtar opines that the medical profession is partial towards pharmaceuticals. Doctors are unethical in the sense that wrong reports are given in rape cases for the sake of money or they do not give adequate evidence to prove rape in the court. Doctors topple health policy and drug policies. For example, gynaecologists don’t take a stand on Depo Provera inspite of knowing its side effects. Medicine can secularise people better than education.
Neha emphasising on the health institutions said that many private and philanthropic hospitals were taken over by government, for example the Nair Hospital was the last to be taken over by the Municipality. Their idea was to secularise.
Sarojini informed about the Pakistan Medical Association which took the stand against the government order to amputate the patients in jail.
Ghanshyam Shah said that medical profession and public health should have a broader political context, putting forth larger political issues and go beyond bio medical terminology. He just put a hunch that if those doctors who are on the other fence votes for BJP but not exactly for “Hindutva” should act.
Chinu said that certain ethical principles can be universally interpreted. By not taking stands we allow new interpretations by Hindutva view.
Beena Srinivasan, due to lack of support from doctors, many rape cases or sexual assault cases have not been registered in Gujarat. There were 300 rapes and only 5 complaints. If some doctors would have said ‘this is our work’ it would have made a great difference.
Mani referred to the areas which were identified as priority areas where there is need to put efforts are like recognition of fundamental universal ethics, guidelines for international standards of quality of care etc. We need to go beyond medical ethics. Just appealing them won’t help, there is also a need to actively try to involve doctors in the ethical debate.
Post Lunch
Session
“Experiences of Conflict Situations and Role of Health Services in Different Countries/ Regions”.
Presentation by Farida Akhtar(Ubinig, Dhaka), Amar Jesani and Suneela Abhayasekhara’s paper, Sri Lanka by Neha Madhiwala
Amar Jesani
He opines that most of the groups in India are inward looking, as far as the international arena is concerned. There are lessons to be learnt from the way torture and the role of medical profession was viewed in the international arena. It is not enough to have a national experience but an international experience is also needed. As it happened in Latin America in 1970s, who had the capacity to internationalize the national issues of torture and the role of medical profession. Health as an issue become a part of the debate resulting in having a separate covenant on Health in ICESCR.
In 1970s and 80s we also found the issue of doctors role in the civil and political riots in the times of tradition of unrest, military reasons in these areas, namely Chile, Argentina The doctors came out with stories and some of them did after they came out of detention. They joined the relatives of the missing victims in searching for them.
Pakistan Medical Association refused to aid Zia ul Haq in interrogations/floggings and amputations. The need to come out and support was then taken up by Pakistan Medical Association. Amar Jesani points out strongly that this kind of a thing has to happen in Gujarat also as the members of the profession were privy to the atrocities and refused to document these, this is not an easy task but it needs to be done. It is necessary to create conditions where people can speak out. There is a need to use the existing services, the medical association came out with a document that reported HR violations in refugee camps.
Mechanism are being developed and need to be developed in India to make the medical profession accountable. India has made several commitments towards upholding human rights, there is a need to find ways of doing it. However we may be, we are still a profession. We need to use ethics and human rights together. Documentation is very important and the need to bring it into national and international bodies and present it through journals. The struggle has to be taken up.
(2) Neha Madhiwala
She presented Suneela Abhayshekhara’s paper titled “Role of Medical and Health Personnel in a conflict situation: Some thoughts on the Sri Lankan experience.” (MFC Bulletin November-December2002)
The ethnic conflict in Sri Lanka led to mass killing. During the conflict, the security forces withdrew from parts of north and east and those territories passed into the hands of the LTTE. The civilian population of these areas was deprived of access to public distribution services which are free for citizens; The withdrawal of State health services and personnel from areas under LTTE control are attributed to the insecurity prevailing in the area, the breakdown of infrastructure and the reluctance of medical personnel to serve in those areas.There is disability among many due to land mines, leading to a high rate in torture and suicide.
International organizations like MSF, ICRC offer rudimentary primary health care- these and medical professions were able to negotiate cease-fire on Pulse Polio Day.
As the conflict intensified in the north and the east in the 1990s, keeping track of the civilian population that was almost permanently mobile became a major issue. Under the embargo that was imposed by the government on the transport of goods to the north and east, essential items such as cotton wool, surgical spirits and paracetamol were controlled and there were shortages of the primary drugs thus leading to great consequences.
With regard to sexual abuse it was pointed in her paper that the survivors do not want to come up and report because of the stigma attached and no social support offered . Documentation is difficult as health professional are terrorized. Even the judiciary has not played a proactive role in protecting human rights. Several doctors were detained, arrested and killed. Parts of the north and east have been unserviced by medical professionals for many years due to the insecurity and difficult condition prevailing there. Lack of security for hospitals has also been a major issue. For example there have been occasions when the premises of the Jaffna Hospital has been the site of fighting. in the same way the violence in the hospitals in south, directed at doctors and nurses as well as other health care professionals, and against patients has led to serious incidence including Trade Union actions and the closure of hospitals. It is only in 2002, that the Sri Lankan Medical Association drafted a Human Right’s Code of Ethics for Doctors.
There is a strong need for documentation, provision of legal services is also a pressing need along with counseling and health services to the victims. In all situations of armed conflict, it is clear that acts of torture, brutality, mutilation, mass rape, genocide and other crimes are committed within a context characterized by the breakdown of the law enforcement and judicial systems.
(3) Farida Akhtar
Elaborated on the Chakma tribal people of the Chittagong Hill Tracts who are difficult to approach due to the rough terrain. They do not have good education and have only admission rights, there is a decrease in Adivasi Quota and a severe lack of health services.
Due to lack of primary health care there is evidence of high mortality due to malaria but very few deaths were recorded. There is lack of doctors, while there are 267 positions only 102 were filled and those filled are punishment postings.
Family Planning services are however stronger like forced sterilization, depo-provera is also taken up. Young Chakma girls face sexual assault and rape by plain lands people. In some places mission hospitals are present and many tribals have been converted to Christianity, they do not mind giving up their cultural practices to bring about health services.
The Bangladeshi Constitution is considered partial by her, only the Bangla speaking people are considered nationals and the tribals are thoroughly neglected. However doctors show good response during disasters such as floods and cyclones but here also they do not have a proper preparation. apart from natural disasters, the doctors role is hardly found in communal or political conflicts. During a rape case or a protest the doctors hesitate and usually support police over the victim.
Adivasis are less than 0.5% of the population , out of 13 tribes only 3 tribes have a stable population growth while the rest have a declining population. Half a million of Adivasis are spread over 5% of land, there total population is 126 million. The psychological trauma they face is tremendous.
She emphatically pointed out that doctors are like actors not good for repetitive work(FHWs are better) that is why there are OTs and not operation rooms. Bangladesh has 3 crisis centers stuffed with trained people but unfortunately
soon transferred out.
Adding up to Farida’s presentation Zafurallah said that doctors can give pills and injections but do not have the ability to organize villagers for a hand pump. He said that the doctors were frequently transferred on the basis of promotion or punishment. The 500 health centers were to go to the NGOs. The Para-professionals are not only in third world countries but is also quite prevalent in England and USA. Medical professionals vehemently oppose to it.
Sabu George related sex determined abortions to communalisation and conflict.
Satya talked of the armed conflict in North-east which she equated to a war. Here the situation of both the victims and care takers was filled with anxiety and depression. This has been the only intervention so far by MFC.
Manisha felt women to be in the most precarious position. NEN consciously used CEDAW, but identity and dress code were the ones to be pointed out sharply.
Day II 29-12-2002
Sesson
IV
Presentations by Renu Khanna, Bina Srinivasan, N.B.
Sarojini, Trupti chaired by Jaya Velankar
(1) Renu
Khanna
Her presentation revolved around the women’s health and sexual assault within the Gujarat carnage. She pointed that the situation in Headband and Panchmahals were worse than what happened in Baroda. The health issues that emerged as far as women were concerned were mostly mental health issues as they had lost their family members. The health was moved both at mental and emotional level because there was extreme loss and insecurity present within the minds of the people.
While doing a fact finding study it was seen that physical health outcomes were not a result of communal violence but of police brutality. For over three months, police again and again were barging into homes, violating privacy and inflicting injuries on pregnant women and injured ladies. Police do not even take actions on the complaints they receive. Police were harassing; especially women by entering into the houses, sexually assaulting them and physically hurting them. When the complaint was made to the Police Commissioner he said that it was not his responsibility and he was helpless in regard to this matter. As a result women shifted to camps/shelter, due to the prevalence of the issue of insecurities, and some even went to camps even in Rajasthan.
The next area of concern during the presentation was the sexual assault that was seen in this riot, especially to the Muslim women. There was also an extended curfew period and several questions were asked, like was assault only rape or also police orally abusing and hitting out with rifle butts in genitals/ abdomen and stepping on children. She emphatically asks the participants as to what is meant by ‘rape’? Puerile penetration?, what about mutilation/insertion of objects, women who are in hiding and/or pretending to be dead to avoid being raped yet again.Is it not necessary to add these types of assault in the dictionary of rape.
In the middle of violence, Mental health program in Gujarat was funded by the Dutch government. Consultations took place without addressing the issues happening around, like selective amnesia. A sub-committee was formed to formulate state gender policy in which still many questions remain unanswered. She henceforth pointed out that we are not asking enough questions.
She did not deny that there were many challenges present in the field of activity. She says that enemies out there are larger- we must align ourselves and define the enemy. Communities were rallying around but somehow this was not enough. There are several organisations working on this issue but the dilemma is that there is no such intervention present in order to face the challenge. At present the intervention required is to be focused and build alliance with people and organisations having the required expertise.
She concluded by saying that we need to move out of our little NGO worlds, develop skills and challenge each other but also need to be focused and have a sound strategy in focusing the international attention that we get.
(2) Bina
Srinivasan
She started by giving some facts about Hindutva and its effect on the societal structure. Within the gamut of Hindutva logic women are central and are projected as reproducers of life. An ideal Hindu woman; the Brahmin, upper caste were looked to be pure and chaste, were given a legitimate space . While a Muslim women, living in dirty surroundings, and also like the Muslim men are oversexed and hence ‘available’ so deserves to be raped. At Human and social level this defies explanation.
A systematic propaganda took place; that Muslim men are abducting Dalit and Adivasis women and converting them and so the only way to teach them is to rape Muslim women. Even the women participated actively in the atrocities, like the Hindu Dalit women stripped Muslim women and made them ready for rape. Hindutva has provided space to these Hindu and Dalit women; people were given rewards for participating; material and also objectively saying things like ‘You have contributed to the building of the Hindu Rashtra’ and “Gujarati Asmita”.
Initially in Muslim community the horrors were so great and they even came with many injuries and abuses of which they were ready to talk about. But later the men of the community, through a silencing community decided how much a woman is to speak and not speak. As a result mass marriages took place in camps and many young women were married of quickly. She explained it to be that ‘families wanted to shift off the protection factor and also the question of ‘what if she is pregnant’ or what happened to the women who conceived after rape? Bina showed the audacity of what the members of the Sangh Parivar said ‘they are celebrating and having lots of sex’.
Apart from all these there is a severe lack of sanitary and hygiene facilities in the camps. During menstruation, women were not even allowed to wash cloths. It was not the only incident, but for many years it is happening in North-east. The South Asian Women’s Watch showed great many incidents, covering not only “riots” but also genocide and carnage.
She concluded by saying that how do you address trauma of violence, displacement, the justice system/police being against you etc and most importantly when the perpetrators are going scot free; overall insecurity and lack of safety/ livelihoods with economic boycott especially in Panchmahal & Ahmedabad is to be noted.
(3) Sarojini
Sarojini shared the experience International Initiative for Justice in Gujarat initiated by women’s groups and civil rights initiatives. The IIJ comprised of activists, panelists, lawyers, writers and academics from all over the world to Gujarat between 14th to 17th December,2002.
The mission of the IIJ is to bring to light the pogrom against Muslim communities in Gujarat in recent months undertaken by anti-democratic forces within the Hindu Right. The specific mandate of the IIJ Panel included investigation of physical and sexual violence suffered by women since 27th February 2002. The panel has also addressed the complicity of the State in the violence, the lack of effective redressal for the victims and the implications of the recent BJP victory in the state.
During their visit they came out with the conclusion that though normalcy has been restored but the patterns of continuing violence that totally marginalize the Muslim Community can still be seen. She said that they met many Muslims who had been displaced due to the attacks on their villages and are not allowed to return to their homes. They continue to live in a state of limbo, unable to work, unable to send their children to school and with a deep sense of physical and mental insecurity. Muslims are even facing with economic boycott not being able to return to their jobs or business.
She even shared her experience of the recent elections in Gujarat. She said that the Muslims of Gujarat saw the elections as their last hope. Sarojini said that they saw that they came out in large numbers to exercise their franchise as citizens in spite of widespread intimidation including use of hate speech and direct threats through their polling. But in the post election where the BJP won in all area the total scenario was changed. On the one hand the election results give the perpetrators of violence in Gujarat a legitimate platform from which to deny that violence of this scale ever happened. On the other hand at the local level the pre-election as ell as post election victory slogans not only explicitly admit the violence but also hold out the threat of its continuation.
She said that IIJ met people at NHRC, Parliamentary committee. Sarojini ended up saying that the most immediate need remains to guarantee safety, legal and social justice to the victims of violence in Gujarat at the individual and collective level of which women should be given the priority.
Trupti
She started by acknowledging that severe form of violence had taken place. Women were forced to withdraw complaints/statements. Most of the people do not realise that such things have happened in Gujarat.
She communicated about a meeting conducted by Purnima Advani, NCW appeared to be listening to the mis-happenings with them. After the meeting was over she fired on police about some immediate action to be taken place but till now no such action has been taken place. Slowly it resulted in that the women had become exhausted and have steadily started withdrawing the cases. In the NCW report also nothing has been mentioned about the Police and the sexual assault that had been taken place at a larger scale in Gujarat. She also spoke about the volunteers in the hospital where they mostly belong to the Sangh Parivar. Thus the life of every individual is at risk with no intervention taking place. After one week nothing happened till now. NCW report does not mention anything about police. There was a heavy presence of Sang Parivar women in these hearings; also NGO women who were sympathetic to the cause of Hindutva.
She strongly felt like other members of the team that there is a need to collaborate at the Asian level. The need to address the intimidation of the groups in Ahemedabad, Panchmahal- move together by developing a strategy. We also need to try to interact with the right wing forces.
Counseling and mental health issues
Presentation by Manisha Gupte
Manisha initiated the presentation with the negligence of the Mental Health issue in the public as well as in private sector. Though people have started fighting in Mental Health arena but the question arises as how to manage in a conflict situation as it happened in Gujarat.
Existing mental health field is not adequate. There is a lack of rationality about mental health drugs and issues. There has been no long term planned interventions in Gujarat maybe because we do not do enough, so whatever was done was thought to be good enough. What is ethical and non-ethical is still not known due to the lack of awareness about the Mental Health issue. At the end one big question arises as what is needed to done and what should one do to work on this issue?
Repeated trauma, unresolved grief, anger, feeling of revenge, suicides, depression are the severe after effects of the violence. The 1994; Campaign to stop hysterectomy of mentally disabled women. Photography and video voyeurism is another case in point. There were many cases of Post Traumatic Stress Disorder (PTSD) detected especially among children. Counseling is required especially among the children where in we saw hands with claws coming out of fires.
We have essentials women and biological sex- we need to understand Right wing women and their ideology- religion and caste might be acceptable as an identity to these women while not accepting feminist ideology, we need to realign. She presents the view as seen from both sides of the coin, the psyche of the Muslim people has changed, now the pressure was felt on the Muslim women to produce more male children to compensate for the ones lost in the riots. While the psyche of the Hindu women is that they might be living with rapists, killers and torturers. They have killed and raped other’s daughters to protect our daughter!! She felt that nothing could be done to heal the rift.
She also gave a contrasting situation within this annihilation like watching your parents having no authority in camps then the sons usually start flaunting and talking back to parents due to a feeling of betrayal. She asks vehemently as to “Can people behave well in an abnormal situation? What has to be done, do we allow people to adjust to the fundamentalism”.
While concluding she said that we need to realign, to understand women choosing of their own will. Though religion, caste might be acceptable to these women while not accepting the feminist ideology. Hence, the need is to join forces.
Sabu commented on Trupti’s presentation that we can seek little justice by approaching to International agencies who are more crucial.
Mira Shiva came out with a suggestion that sexual violence must be made a part of the RCH programmes. She also added that the doctors have purposely dumped some women in mental asylums. It was due to the lack of knowledge about mental health arena. Thus more of technical expertise and training are required to enhance the doctors in the field of mental health.
Veena put forth two points:
She said that ‘genocide’ cannot be addressed as a grief. It is not a question about an individual grief but rather should be looked upon as the community grief. She asked whether the mental health professionals would even address the issue. We need to make it possible.
She pointed towards the aftermath of the conflict situation, like after the partition most of the people have lost their minds, severe breakdowns at home. There will be many individuals who would be committing suicide or would try to commit suicide due to the lack of courage present within them to face the world. Some demands should be made to avoid this kind of situation. The UNICEF / WHO have spent all on Iron and Floric Acid &TT, but not on many other pressing needs. Aren’t they accountable to the various crisis situations?
Sathya gave some recommendations:
• Rape as an act of tortured genocide should be included in the
International law (Indira Jai Singh).
• The impact of violence is so much that instead of giving individual counseling it is better to give group counseling which would be more effective (Nandita Haksar, Manipur).
• PTSD is not an accepted therapy. Only justice is the therapy.
• Violence should be seen in a holistic manner.
• Should not label communities and not to make religion as a means of violence.
• The concept of sisterhood of the western feminists is not enough. There is a need to include race, class and also secular images.
Farida mentioned that rape not only an act at a particular point of time but carries on all through the life. She exemplifies by adding that in 1971 war many women were raped by the army. Even after so many years the women are scared in saying that they were raped. These women were called biraangana, pagal. which is a severely stigmatised socially. It is not possible to separate mental health and sexual assault. We as feminists, should be self-critical and look into these issues. It will help us to have a better understanding about the issue and thus bring in productive results.
Narendra said that the field situation is entirely different., where most of the people have strong ideologies . But there are other factors which determine actions, like the orders from seniors. The heads of NGOs are secular because they are heads of the NGOs. They do not learn conceptual issues, like RCH=MCH.
Shailu said that Muslim women were the major victims of this riot. There were some serious repercussions with the Muslim community becoming more rigid towards their women. The kind of assault has changed from sexual to natural. On the other hand Hindu women only have some idea about the incidents that have taken place. The camp comprised women from both Hindu and Muslim community. So efforts should be made to have group meeting with both the communities, trying to enlighten the masses and bringing out some positive results.
Chinu suggested a. community should demand reparations b. to include sexual violence in proposals to funders.
Sanjay
Nagral said that looking at various experiences we have started talking
about international help which, is actually double-edged. Instead we can make
use of the expertise in analyzing evidences. He also came up with the suggestion
of complaining to Medical Council of India to disqualify Praveen Togadia’s Medical Degree.
Sunil
mentioned about the parliament attack , during this time UN agencies went into
“Phase III”. There are no UN agencies in Gujarat. Moreover, the government is
only worried about its investment and economic blockade.
Neha talked of how more and more girls are being pushed under ‘purdah’ . Our identities are forced upon us. No one trusted them, but women as an issue was always taken up as an opportunity to talk. Hence we need to work on legitimacy.
Amar responded to the earlier statements that sexual assault always is given importance in investigations internationally.
Satya says that Narendra Modi may not have raped directly but have been an equal participant in such an act.
Amar suggested to create a council with a neutral medical space to provide care and treatment. We need political alliance. As a matter of fact ghettoisation in inevitable, as people will need separate medical services. We need to have space in our strategy, looking at the Israel and Palestine on both sides attempts to set up services.
Bina said that community grief needs to be addressed. MFC has not tried to understand the psycho-social aspect. She emphasised that presently a lot of Muslims want their girls to be educated as a reaction to the Mullahs. When we start by saying that he/she is a ‘ Hindu’ is a part of the strategy that raises debates.
Trupti said we need to be clear in our politics and try to create a neutral space to win them over. We need to cover all fronts, everywhere, the whole country as a whole. People must understand whatever has happened is bad.
Abhay said Right to health care in emergency situations should be emphasized.
Zafarullah pointed out that violence in conflict situations & health should be a part of the medical course.
Dhruv emphasised on the need to communicate with other groups who are from the mainstream.
Mani gave certain insights as to the following
• To develop a cadre of young professional & students from the social sector, doctors, engineers etc.
• Role of volunteers in Hospitals has to be seriously looked into. Most of the members belong to the Sangh Parivar. Many of us are inadequate because we haven’t got enough knowledge of religion to counter the gatekeepers of religion.
• Need to contexualise sexual assault, and also there is a need to document the experiences. Since, it was seen that all violence including sexual violence is put under the carpet. Mental Health issues are usually neglected.
Post -
Lunch
Sharing of
local experiences
Dr.
Bandukwala
He said that after the Gujarat carnage there has been a severe poisoning of the community with vast changes in the life of Baroda. Maximum hatred was seen against Muslims by doctors and university professors. A paranoid hatred against Muslim community was found among the Patels. Gujarat will suffer for decades as the poison has sunk so deep. There is no middle space. He gave a sad analogy of a small village named Khera. A school master asked Muslim students to get up and go out. He then took them to a nearby well and dumped them one by one in the well in the name of Jai Shri Ram.
Then he enquired what you can do to remove hatred.
Togadia ceremoniously keeps telling the people to remove hatred from our lives and those around you. We find that the top level people have absurd notions and are misin